Evaluation of the approach to before and after pandemic neutropenic infections in chemotherapy-related neutropenia in patients with acute myeloid leukemia treated in the hematology service

Introduction: Infection is one of the most important cause of morbidity and mortality in patients with acute myeloid leukemia. For this reason, it is vital to be able to detect infections at an early stage and to determine appropriate treatment regimens. The pathogen profile of each clinic plays an important role in empirical antibiotic selection. COVID-19 pneumonia causes clinical manifestations such as acute respiratory distress and sepsis, which can be fatal. The COVID-19 pandemic has brought with it many changes in the field of health. In this study, we aimed to comparatively evaluate the neutropenic infection approach, agent profile, treatment regimens and mortality rates in the pre-pandemic period and during the pandemic period. Materials and Methods: 100 patients diagnosed with AML followed between 01/01/2017 and 01/05/2022 at Dokuz Eylül University Hospital Hematology Clinic were included in the study. The demographic characteristics of the patients, laboratory parameters, culture results, imaging results and whether the infection attack resulted in mortality were recorded. Results: A total of 100 patients, 42 female and 58 male, were included in the study. In 100 patients, 198 episodes of FN were reported. The mean age of the patients was 59.1 ± 12.8 years. 19.2% of the 198 attacks evaluated resulted in mortality. Of the 198 episodes, %49,7 were microbiologically documented. At the end of a median follow-up of 14.23 months, 36% (36 patients) were still alive and 64% were found to be ex (64 patients). Mean duration of hospitalization was 125,5 ± 86 days. The most commonly used chemotherapy was ARA-C + Idarabucin (7+3) with 42.4%. The most common bacterium detected in patients with bloodstream infection was coagulase-negative staphylococcus (34.2%); this was followed by ESBL negative E. coli (24.5%). 51% of the patients were diagnosed during the pre-pandemic period, 49% of the patients were diagnosed during the pandemic period. When the two groups were compared, differences were found in the frequency of febrile attacks, mean duration of hospitalization, mean CRP, albumin and creatinine values, and prophylactic antifungal use. Need for mechanical ventilator, need for vasopressor, need for parenteral nutrition, development of bacteremia, not being in remission, prolonged neutropenia were found to be associated with mortality. Age, number of FN episodes, having diabetes mellitus and lung disease, AML risk group, AML transformed from hematological malignancy were associated with survival. Conclusion: It is the most accurate and rational approach to reduce morbidity and mortality in the empirical treatment of febrile neutropenic patients, rapidly regulating the frequency of microorganisms isolated in local epidemiological data and the susceptibility profile results, and modifying them according to clinical course and microbiological data, if necessary. The follow-up of the cases in isolated rooms and the pandemic precautions taken, no difference was observed in neutropenic infection factors and mortality rates during the pandemic period, and the shortening of the hospitalization period did not have a negative effect on patient follow-up during this period Keywords: Febrile neutropenia, COVID-19 pandemic, infection, AML